Public Health and the Leadership Imperative

Government leaders long ago took up the challenge of protecting the public from deadly diseases. New challenges are testing that resolve.

Who thinks about the broad needs of our society? Private-sector leaders focus on the bottom line and their products. As individuals, each of us is consumed by our personal responsibilities, goals and challenges of daily life.

That's why it's so important for government officials to take a leadership role to advocate for future generations. Who else has the capacity and orientation to rally the public to make essential investments in infrastructure, education and the general welfare? Foresight may, in fact, be the most important skill set in the public leader's toolbox.

Take public health. A hundred years ago, cities faced massive public-health challenges, with high death rates from tuberculosis, bubonic plague, smallpox and malaria. Local-government reformers and the first city managers tackled these challenges with passion and rigor. When community leaders found evidence that strategic investments could dramatically improve public health, they built water and sewer systems and brought together community resources to tackle contagious diseases.

In 1923, for example, Louis Brownlow, city manager of Petersburg, Va., reported dramatic results after public and private agencies coordinated their efforts under the leadership of the city's health officer: The general death rate had decreased from 19.2 per thousand people in 1920 to 16.64 in 1922 and infant mortality had dropped from 189 in 1920 to 106 in 1922. "After two years it is almost impossible to discover ... what part of the health center work is done by the city, what by the Red Cross, the Kings Daughters, the Tuberculosis Society, [or] the Milk Fund," he wrote in the yearbook of the City Managers' Association.

Similar results were reported in Beaumont, Texas, where City Manager George J. Roark wrote that he had hired "the best sanitary engineer" to improve the city's water supply. Consequently, by 1922 malaria had been reduced by 50 percent and tuberculosis in the milk supply had been eliminated.

Where are we today? Just as budget cuts during the Depression years threatened public-health efforts, new strains on health-department budgets threaten to reverse some of the gains of the past century.

Of particular concern is the impact on the public-health workforce. Research released in November by the Center for State and Local Government Excellence and the University of Illinois at Chicago found that local health-department leaders are particularly concerned about recruitment and retention. Retaining funded positions has become especially difficult, and opportunities to promote well-qualified people are limited due to human-resources rules and regulations.

The study, funded by the Robert Wood Johnson Foundation (RWJF), reinforces worrisome state-level findings released last month by the Trust for America's Health and RWJF: Two-thirds of the states decreased public-health funding over the last five years, eliminating 40,000 public-health jobs, according to that report. And just two states and the District of Columbia have met the U.S. Department of Health and Human Services benchmark to provide whooping-cough vaccinations to at least 90 percent of preschool children.

These are serious issues, ones that simply don't lend themselves to private-sector or personal solutions. At the end of the day, we count on government to sound the alarm and assume leadership responsibility. If government lacks the wherewithal or the will to effectively address an issue as broad and important as public health, who will?

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Elizabeth Kellar is president and chief executive officer of the Center for State and Local Government Excellence and also serves as deputy executive director for the International City/County Management Association.